Tag: Coverage

Answers to Your Most Common Questions

Summer is the perfect time for seniors to embark on new adventures, whether exploring national parks across the U.S. or visiting exotic destinations abroad. As you plan your travels, understanding how your Medicare coverage works away from home is crucial. Here, we address the most frequently asked questions about Medicare and travel, ensuring you’re well-prepared for any health-related needs during your summer journeys.

Coverage Outside the U.S.: Does Medicare Cover Medical Care While I’m Traveling Abroad?

A: Original Medicare generally does not cover healthcare services outside the U.S., except in limited situations such as emergencies in Canada or when traveling through Canada on your way to Alaska from another U.S. state.

Medicare Advantage Plans: What About Travel Coverage?

A: Some Medicare Advantage plans offer travel benefits that extend beyond emergency and urgent care. These benefits can include coverage for routine health care services whether you are vacationing within the U.S. or abroad. It’s essential to consider that coverage details, rules, and limitations can vary significantly between plans. When selecting a Medicare Advantage plan, ensure it meets your travel needs by asking:

• What emergency or routine health care services are covered if I vacation in the U.S. or out of the country?
• Do I have to seek services with specific providers?
• How long can I be away from home and still receive coverage?
• Will this plan cover both domestic and international travel?

Prescription Drugs Abroad: Does Medicare Cover Them?

A: Medicare Part D does not cover drugs purchased outside the U.S., but certain travel-related vaccines might be covered.  Medicare Advantage plans do no cover prescription medicines or routine health care services overseas. This means you might be paying 100% of the costs of care.

Using Medigap Policies for Travel: What Do You Need to Know?

A: Medigap (Medicare Supplement Insurance) policies provide emergency health coverage for the first 60 days of your trip outside the U.S. During this period, the policy typically covers 80% of the costs for medically necessary emergency care, as defined by Medicare. It’s important to note that Medigap plans are not designed to cover non-emergency medical services or surgeries abroad. Instead, they aim to stabilize your condition for transport back to the U.S.

Can I Use Telehealth Services While Traveling?

A: Some Medicare Advantage plans offer telehealth services that allow you to consult with healthcare providers remotely. Check with your plan to see if telehealth services are available while you’re traveling within the U.S. or abroad.

What Should I Do If I Need Medical Care While Traveling Abroad?

A: If you need medical care outside the U.S., you generally need to pay for the services upfront. Foreign hospitals are not required to file Medicare claims for your travel medical costs. You’ll need to submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services if you’re admitted to a foreign hospital under specific circumstances and the hospital does not file Medicare claims for you.

Travel Insurance Options: Should You Consider Additional Coverage?

A: Due to limited Medicare travel coverage, many seniors opt for supplemental travel insurance. Review policy terms carefully.

Cruise Ship Coverage: What’s Covered by Medicare?

A: Original Medicare (Parts A and B) and Medicare Advantage Plans may cover medically necessary health care services on a cruise ship if the ship is in U.S. territorial waters or within six hours of a U.S. port when the services are received. 

Does Medicare Cover Emergency Air Transportation Back to the U.S.?

A: Medicare generally does not cover emergency air transportation (medical evacuation) from a foreign country to the U.S., except in very limited circumstances where the transportation is considered medically necessary and is provided as part of an inpatient hospital stay that Medicare covers.

Planning Ahead for Emergencies: What Should I Include in My Medical Travel Kit?

A: When traveling, it’s essential to pack a medical travel kit with essentials like medications, copies of insurance cards, emergency contacts, and a list of allergies. Being prepared can help ensure you’re ready for any unexpected health situations that may arise during your trip.

As you plan your travels, it’s important to keep in mind how your Medicare coverage works outside of your home area. Always check with your plan beforehand to understand what’s covered and consider additional travel insurance for added peace of mind. Being prepared ensures you can focus on enjoying your trip without worrying about unexpected medical costs.

If you’d like to review your plan before your next travel, please contact our office today at (631) 738-6760 and we would be happy to assist you in ensuring you fully understand your coverage before you set sail onto your next adventure!

Bon Voyage!

As we soak up the sun this summer, it’s essential to balance enjoyment with skin protection, especially for seniors who face increased risks of skin cancer. Did you know that UV rays from the sun are the primary cause of skin cancer? But fear not! With practical tips and understanding Medicare coverage, you can stay safe and enjoy sunny days responsibly.

Protecting Your Skin: Practical Tips

1. Seek Shade Strategically During peak sun hours (10 a.m. to 4 p.m.), find shade under an umbrella, sunshade, or in shaded areas to reduce UV exposure. It’s your personal oasis from the summer heat.
2. Fashionable Sun Protection Stay stylish and sun-safe with loose, breathable clothing, a wide-brimmed hat, and UV-blocking sunglasses. Protect yourself from head to toe while looking your best.
3. Sunscreen: Your Skin’s Superhero Always apply broad-spectrum sunscreen with SPF 30 or higher. Reapply every two hours (more frequently if swimming) and opt for waterproof formulas for continuous protection.
4. Embrace Vitamin D Wisely Maintain strong bones with vitamin D-rich foods like salmon and dairy products. Consult your doctor about supplements for additional options beyond sun exposure.
5. Review Your Medications Certain medications can increase skin sensitivity to sunlight. Discuss your prescriptions with your healthcare provider to stay informed and protected.
6. Stay Cool and Hydrated Beat the heat by staying hydrated and wearing lightweight, breathable fabrics. Moisturize regularly to keep your skin healthy and hydrated.

Early Detection Saves Lives

Monitor your skin for changes such as unusual moles or patches. Promptly notify your doctor if you notice anything concerning – early detection is crucial for effective treatment.

Understanding Medicare Coverage for Skin Cancer

The senior population faces significant risks from skin cancer, with over 40% of melanoma cases in the U.S. occurring in those aged 65 and older. Here’s how Medicare supports your skin health:

1. Medicare Part B Coverage
   • Routine skin cancer screenings are not covered for asymptomatic individuals under Medicare Part B.
   • Medicare Part B covers doctor examinations if you notice changes in moles or skin growths. If further evaluation is needed, Medicare may extend coverage for specialist referrals.
2. Coverage for Treatment
   • Medicare Part A and Part B cover outpatient treatments for skin cancer after meeting deductibles. Hospitalization costs are covered under Part A after its deductible is met.
3. Annual Wellness Visits
   • Medicare Part B offers annual wellness visits, providing an opportunity to discuss skin health concerns with your doctor. The visit is covered without applying the Part B deductible.
4. Medicare Advantage and Prescription Coverage
   • Medicare Advantage plans cover the same benefits as Original Medicare (Part A and B) and may offer additional coverage options.
   • Medicare Part D plans cover prescription drugs used for skin cancer treatment, expanding coverage beyond Original Medicare’s limitations.

Whether you’re considering Medicare Advantage or need comprehensive coverage insights, exploring your options ensures you receive the best care for your skin health needs. Stay informed, stay protected, and enjoy the sunshine responsibly this summer!

If you have further questions about your Medicare coverage, or would like to schedule a plan review, please contact our customer support services.

As we journey through life, the health of our brain becomes increasingly important, especially for those of us who are Medicare beneficiaries. June marks Alzheimer’s & Brain Awareness Month, a time dedicated to raising awareness about Alzheimer’s disease, other dementias and emphasizing the importance of brain health. Understanding your Medicare coverage benefits is key to taking proactive steps to support your cognitive well-being.

Understanding Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia, affecting millions of people worldwide. It is a progressive brain disorder that gradually impairs memory, thinking, and behavior. While aging is a significant risk factor, Alzheimer’s is not a normal part of aging. It affects about one in nine people aged 65 and older, making it a critical issue for the Medicare community.

The Alzheimer’s Association defines three general stages of Alzheimer’s:

Early-stage Alzheimer’s (mild)

Middle-stage Alzheimer’s (moderate)

Late-stage Alzheimer’s (severe)

“Every 65 seconds, someone in the US develops Alzheimer’s.”

Alzheimer’s Association

Early Detection & Brain Health with Medicare Coverage

Early detection of Alzheimer’s can make a significant difference in managing the disease. It’s important to understand what’s included in your Medicare Benefits.

Original Medicare (Part A and Part B) will typically cover the diagnosis, evaluation, treatment, and care planning for Alzheimer’s at every stage. Original Medicare (Part A and Part B) will typically cover the diagnosis, evaluation, treatment, and care planning for Alzheimer’s at every stage.

Medicare Part A will cover:

• Inpatient medications (prescription drugs you may get during an inpatient stay)
• Medicare covers inpatient hospital care and some of the doctors’ fees and other medical items for people living with Alzheimer’s or another dementia who are age 65 or older.
• Home health care can be covered up 35 hours of in-home care per week depending on the circumstances.  To receive this coverage, the patient must be “homebound” and need part-time skilled nursing care.
• Hospice care will be provided under Medicare Part A, with very little in out-of-pocket costs. In most cases, hospice care is provided in a patient’s home.

Medicare Part B provides coverage for a range of essential medical services, including:

• Annual Wellness Visits: Medicare offers a comprehensive annual wellness visit, including cognitive impairment assessments to catch early signs of dementia for timely interventions and better symptom management.
• Part B also covers a separate visit with a doctor or health care provider to fully review your cognitive function, establish or confirm a diagnosis like dementia or Alzheimer’s disease, and develop a care plan.
• Durable medical equipment such as a hospital bed or a wheelchair for in-home use.

Medicare Part A and Part B may also cover different mental health services including inpatient psychiatric are and outpatient services such as counseling and behavioral health specialist care.

If you or a loved one notice memory loss or cognitive changes, don’t hesitate to discuss it with your healthcare provider. Early diagnosis can lead to better treatment options and support services!

Medicare Part D Benefits:

If the person living with dementia has Medicare, then he or she can enroll in Medicare’s Part D prescription drug plan.

Medicare collaborates with insurers and private companies to provide a range of prescription drug plans, each differing in cost and covered medications. During the Medicare Part D annual open enrollment period (October 15th to December 7th), Medicare beneficiaries have the opportunity to enroll in a drug plan. Those already enrolled in a Part D drug plan can also switch to a different plan during this period.

Tips for Choosing Your Part D Plan:

1. Check if the plan covers most or all of the drugs you currently take.
2. Ensure your Alzheimer’s drugs are on the formulary.
3. Confirm the plan covers the doses you need.
4. Review if the plan’s rules restrict coverage of your Alzheimer’s drugs or require prior approval.
5. Check if the plan requires you to try a cheaper drug before covering your current one (step therapy).
6. Look for any quantity limits on pills covered in a given period.
7. Compare all costs, including deductibles, copayments, and coinsurance, not just monthly premiums.
8. Verify if your local pharmacy is in the plan’s network, as mail order may be an option, offer incentives, or be required for prescriptions.

Promoting Brain Wellness Through Healthy Habits

While there is currently no cure for Alzheimer’s, research shows that a healthy lifestyle can help reduce the risk of cognitive decline. Here are some tips to keep your brain healthy:

• Stay Physically Active                          
• Eat a Brain-Healthy Diet
• Stay Socially Engaged
• Keep Your Mind Active
• Get Quality Sleep

Alzheimer’s & Brain Awareness Month is a reminder that while aging is inevitable, we can take steps to protect our brain health. As Medicare beneficiaries, we have access to essential resources and services that can help us maintain cognitive function and quality of life. Let’s embrace this month as an opportunity to educate ourselves, support others, and commit to brain-healthy habits.

Contact us to learn more about your Medicare coverage benefits that can assist you with preventative services to promote your brain and cognitive health.  You can also learn more about what’s included in Medicare Part A and B, and Part D, at Medicare.gov.

During Nursing Home Week

As we observe Nursing Home Week, we want to take a moment to acknowledge the dedicated nurses, caregivers, and staff who provide round-the-clock care to our loved ones. This week serves as a reminder of the commitment to ensuring the well-being and comfort of our elderly population. For seniors and their families, understanding how Medicare intertwines with nursing care is crucial for planning and ensuring access to the necessary services.

Medical Coverage for Nursing Home Care

Nursing homes provide a variety of services and personal care assistance. Medicare coverage for nursing homes, however, varies depending on factors like the specific facility, required services, and duration of stay.

Medicare coverage depends on:

• State and federal laws.
• National coverage decisions made by Medicare.
• Local coverage decisions made by companies.

Medicare Part A Skilled Nursing Facility (SNF) Care:

extends coverage for skilled nursing facility (SNF) care under specific conditions. This encompasses a spectrum of services for a limited time, including the following:

• Hospital inpatient care.
• Skilled nursing facility care.
• Nursing home care.
• Hospice.
• Home health care.

To qualify for Medicare-covered SNF care, a beneficiary must have undergone hospitalization for a minimum of three consecutive days and necessitate skilled care or rehabilitation services that can only be administered within the confines of a skilled nursing facility. 

*Note that a patient must check in to a skilled nursing facility within 30 days of leaving the hospital. On top of that, it must be for the same illness or condition related to the hospital stay.

Duration of Medicare-Covered SNF Care:

• Medicare encompasses coverage for up to 100 days of SNF care per benefit period. Nonetheless, coverage extending beyond 20 days mandates the beneficiary to bear a daily coinsurance amount.
• It’s incumbent upon individuals to familiarize themselves with the criteria governing continued Medicare coverage in an SNF setting, along with the prospective out-of-pocket expenses entailed.

Medicare Advantage Plans (Part C) and Nursing Care:

• Certain beneficiaries may be enrolled in Medicare Advantage (Part C) plans, which are dispensed by private insurance entities sanctioned by Medicare. These plans frequently encompass coverage for skilled nursing care, albeit the specifics may vary.
• Beneficiaries enrolled within Medicare Advantage plans should meticulously scrutinize their plan’s coverage nuances, inclusive of any stipulations or prerequisites concerning nursing care.

Long-Term Care and Medicare:

• It’s imperative to discern that Medicare typically refrains from extending coverage for long-term care in nursing homes for protracted durations. Long-term care requisites, such as assistance with activities of daily living (ADLs) or custodial care, are generally excluded from Medicare coverage.
• Individuals may find themselves compelled to explore alternative avenues, such as long-term care insurance, In-Home Health Care, or Medicaid, to defray the costs associated with prolonged nursing home stays.

In-Home Health Care: A Viable Alternative: In-home health care provides a valuable alternative for individuals requiring assistance with daily activities after a hospital stay.  This option allows individuals to receive care in the comfort of their own homes, maintaining a sense of independence and familiarity. In-home health care services can include:

• Meal planning/preparation
• Assistance with dressing, bathing, toileting
• Light housekeeping
• Accompany to doctor’s visits and other appointments

In-home health care plans are available at various levels and do not have age requirements or underwriting, making them an affordable option for seniors and their families. This option is especially beneficial after a hospital stay when care is needed but does not meet the requirements for nursing facility coverage under Medicare. 

Medicare coverage in nursing homes is a vital resource for elderly and disabled individuals in need of skilled nursing care. While it comes with limitations and eligibility requirements, it serves as a crucial safety net for those who might otherwise struggle to afford necessary care. Knowing and exploring your options to receiving care can greatly impact your quality of life and peace of mind.

If you would like more information and guidance on your Medicare coverage, skilled nursing facility benefits, or in-home health care plans, please don’t hesitate to contact our office today at (631) 476-4015 or email us at mlegaspi@imperial-coverage.com.

Exploring the 3 Ways You May Qualify

Medicare offers Special Enrollment Periods (SEPs) that allow individuals to enroll in or switch Medicare plans outside of the standard enrollment periods. These SEPs are crucial for individuals who experience certain life events or qualify for specific circumstances. Let’s explore what qualifies you for a SEP and how you can take advantage of them.

Qualifying for a Special Enrollment Period

There are three main reasons why you may qualify for a Special Enrollment Period:

1. Qualifying Life Events (QLEs): If you experience a QLE, such as moving to a new area, losing health coverage, or other life-changing events, you may be eligible for a SEP.
2. 5-Star Special Enrollment Period: Medicare rates plans on a scale of 1 to 5 stars, with 5 stars being the highest rating. If a 5-star plan becomes available in your area, you can switch to it during a SEP.
3. Working Past Age 65: If you delayed enrolling in Medicare because you had employer-based coverage, you have an 8-month SEP to enroll in Medicare once that coverage ends.

Qualifying Life Events and Special Enrollment Periods

If you have Medicare and experience a QLE, you may qualify for a SEP to change your Medicare Advantage or Prescription Drug Plan. These events include:

• Changing your primary residence
• Losing your health insurance
• Being eligible for other health insurance

*Each QLE has a specific timeframe within which you must act to qualify for a SEP. For example, if you move, your SEP is typically 60 days after your move.

5-Star Medicare Special Enrollment Period

If a 5-star Medicare plan becomes available in your area, you can switch to it during the 5-star SEP, which runs from December 8 to November 30 of the following year. It’s important to compare plans to ensure the new plan meets your needs.

Enrollment in Medicaid or Extra Help

Most people with Medicare can only make changes to their drug coverage at certain times of the year. If you have Medicaid or receive Extra Help, you may be able to make changes to your coverage one time during each of these periods:

• January – March
• April – June
• July – September

If you lose benefits from Medicaid or Extra Help, you will have a one-time opportunity to adjust your Medicare Advantage enrollment.

Disenrollment from your initial Medicare Advantage plan

If you initially enrolled in a Medicare Advantage plan upon becoming eligible for Medicare, you have a 12-month window to disenroll from the plan and return to Original Medicare.

If you previously dropped a Medicare Supplement Insurance plan to join a Medicare Advantage plan but now want to switch back, you also have a 12-month period to do so (as long as this was your first enrollment in a Medicare Advantage plan).

Working Past Age 65 and the Special Enrollment Period for Medicare Part B

If you or your spouse work past the age of 65 and delay enrolling in Medicare, you have an 8-month SEP to enroll in Medicare Part B once you retire or lose employer coverage. This helps you avoid late penalties.

Avoiding Gaps in Coverage and Part D Late Enrollment Penalties

To avoid gaps in coverage, enroll in Medicare before you lose employer-based coverage. If you anticipate retiring, contact your employer’s human resources department one or two months in advance to time your Medicare enrollment correctly.

Understanding Medicare Special Enrollment Periods is crucial for individuals to make informed decisions about their healthcare coverage. Whether you’re experiencing a QLE, have access to a 5-star plan, or are working past age 65, knowing your options and timing is key to maximizing your Medicare benefits.

If you would like more information on the SEP, or to find out if you may qualify, please contact our office today and we would be happy to assist you.

Choosing the right health plan shouldn’t be complicated. In this blog, we’ll explain the main differences between them, providing insights to help you make informed decisions. Think of this as your handy guide, with essential questions to make your healthcare choices easier and help you confidently pick between HMOs and PPOs.

HMO vs. PPO: What You Need to Know

HMOs are known for being cost-effective with designated provider networks, while PPOs offer more flexibility at a higher cost, allowing you to access out-of-network care. Your choice between the two ultimately depends on your preferences regarding costs and restrictions.

Understanding HMOs:

Health Maintenance Organization (HMO) plans typically consist of an approved network of healthcare providers. In most cases, your medical care is covered only if you visit a provider within the plan network. Going outside this network might mean paying the full cost of services, except in emergencies.

Understanding PPOs:

Preferred Provider Organization (PPO) plans provide you with the flexibility to choose your healthcare provider. Like HMOs, PPOs establish a provider network, usually resulting in lower out-of-pocket expenses when staying within the network. However, partial coverage for out-of-network care is possible, with higher anticipated costs for services beyond the designated network.

Commonalities Between HMOs and PPOs:

Despite their differences, both HMO and PPO Medicare Advantage plans share common ground. They offer the same coverage as Medicare Part A (hospital insurance) and Part B (medical insurance) in a unified plan.

Many Medicare HMO and Medicare PPO plans also include additional benefits beyond what Original Medicare covers.

Key Questions to Consider when choosing between an HMO plan and a PPO plan:

1. Provider Accessibility:
   • HMO: Do you prefer a plan with a specific network of approved providers?
   • PPO: Is having the flexibility to choose your healthcare provider important to you?
2. Cost Considerations:
   • HMO: Are you looking for a cost-effective plan with potentially lower out-of-pocket expenses within the network?
   • PPO: Can you afford the higher cost for the flexibility to access both in-network and out-of-network care?
3. Primary Care Physician Preference:
   • HMO: Do you value having a primary care physician coordinate your care within a network?
   • PPO: Is having the freedom to choose specialists without referrals more appealing to you?
4. Network Restrictions:
   • HMO: Can you commit to receiving most, if not all, of your care within the plan’s network?
   • PPO: Are you willing to pay higher costs for the flexibility to see providers outside the designated network?
5. Coverage Beyond Medicare Parts A & B:
   • HMO and PPO: Are you interested in additional benefits beyond what Original Medicare covers, offered by both plan types?
6. Coordinated Care Preference:
   • HMO: Do you appreciate a team approach to your care within a coordinated network?
   • PPO: Does the idea of having more individual control over your healthcare decisions appeal to you?
7. Freedom of Choice:
   • HMO: Is having a more structured healthcare experience with a designated network preferable?
   • PPO: Do you value the freedom to seek care from any healthcare provider without network restrictions?
8. Personal Healthcare Needs:
   • HMO and PPO: When deciding, consider your specific health requirements, provider preferences, and overall comfort level with each plan’s features.
9. Customer Service and Support:
   • HMO and PPO: What is the quality of customer service for each plan, and how responsive are they to your inquiries?
10. Travel Considerations:
    • HMO: How does the plan handle healthcare needs when you’re outside the plan’s service area?
    • PPO: Are there additional benefits or coverage when seeking care outside the designated network, especially during travel?

Choosing between an HMO and a PPO requires considering key aspects. By asking these questions, you can pinpoint what matters most to you in terms of cost, flexibility, and healthcare preferences. Your ideal plan is the one that aligns with your lifestyle and budget.

To help you weigh the pros and cons and make a confident decision, download this FREE HMO vs PPO Guide.

Your health coverage should cater to your needs, ensuring you receive the best care for your unique situation.

If you would like additional assistance with plan comparisons, please contact our office today and we would be happy to schedule a review to ensure your Medicare needs are properly in place for 2024.

Resources:

Medicare.gov

www.uhc.com/news-articles/medicare-articles/the-difference-between-medicare-hmo-and-ppo-plans